Living With Diabetes. Working For Change

Every year on World Diabetes Day, I reflect on my diabetes journey, as well as others’, seeing how far we’ve come — and how far we still must go. For me, this day is personal.

My name is Delfina Boudou, and I’m the Programme Manager for ISGlobal’s Public Health Liver Group. Every year on World Diabetes Day, I reflect on my diabetes journey, as well as others’, seeing how far we’ve come — and how far we still must go. For me, this day is personal.

I was diagnosed with Type 1 diabetes when I was sixteen. Until then health had been something I took for granted. I went from worrying about exams to learning how to count carbs and inject insulin. It was a crash course in responsibility. Before I had even finished university, I was diagnosed with another chronic autoimmune disorder, Hashimoto's disease, which affects the thyroid gland. It all led me to see how connected our bodies, our minds and our environments are. One imbalance affects another. Nothing happens in isolation.

Living with Type 1 diabetes and hypothyroidism has made me stubborn in the best way. I don’t believe in perfect systems, but I believe in fair ones. I believe in healthcare that reaches people early, and that doesn’t depend on your income or your postcode

Health can be unfair. Some people have support, some don’t. Some have access to insulin; others fight for it every day. Throughout my life I have lived in various health systems, with varying access to care, and what is clear is that access to proper care greatly defines your health outcomes even if you do everything right.

Living with 2 conditions. Living as 1 person

When you live with multiple conditions, you see how fragmented care can be: doctors treating the same person as separate cases. You also see how privilege shapes everything — who gets diagnosed, who gets time, who gets treatment. I don’t say that as theory. I’ve lived it. And that’s partly why I ended up here in ISGlobal.

When you live with multiple conditions, you see how fragmented care can be: doctors treating the same person as separate cases. You also see how privilege shapes everything

In the Public Health Liver Group, our work has evolved from a primary focus on infectious diseases to a broader commitment to liver health. Our values, nonetheless, remain constant: advancing equity and placing people at the centre of care. We support health systems to address conditions as interconnected rather than isolated.

The META Trial team.

The META Trial is an example of this ongoing legacy. It directly links my professional work to the diabetes community. The study aims to identify a low-cost intervention to prevent or delay the onset of type 2 diabetes in individuals living with HIV and pre-diabetes who are on antiretroviral therapy (ART) in Tanzania. While liver disease may not fall squarely within its scope, the trial embodies the same principle that guides our current work: integration. It shows how understanding the connections between conditions, and preventing illness in one area, can strengthen health across others.

More Than a Research Aim

Because whether it’s HIV, COVID-19, diabetes, or liver disease, the story is often the same: shared roots in metabolic dysfunction, inequity, and limited access to care. That’s why our group works to make liver health part of the broader non-communicable disease conversation, bridging the gaps between infectious and non-communicable conditions. We want systems that reflect how people actually live… that is, often with multiple conditions, not single labels.

Living with Type 1 diabetes and hypothyroidism has made me stubborn in the best way. I don’t believe in perfect systems, but I believe in fair ones. I believe in healthcare that reaches people early, and that doesn’t depend on your income or your postcode.

Chronic conditions aren’t just medical; they’re political, economic, and human.

And for me, they’re also a daily reminder of why I do what I do. Because integration isn’t just a research goal. It’s personal.